Okura Psych-Mental Health Fellow Application Mentee Form. City State Zip code. 1. Membership in AAPINA from (date):

Transcription

1 Okura Psych-Mental Health Fellow Application Mentee Form Name: Date: Address: Mailing address City State Zip code Phone: Degrees/Credentials: Employer: Organization/Agency Address City State Zip code 1. Membership in AAPINA from (date): 2. Number of years employed as a psych-mental health nurse: 3. Do you currently work with psych-mental health patients? Yes No a. If yes, how many hours per week do you work with patients? b. What percentage of your patient population are Asian Americans/Native Hawaiian or other Pacific Islanders? 4. If selected as a fellow will you be willing to attend and present at the annual AAPINA national conference? Yes No If selected as a fellow will you be willing to serve as a mentor for future fellows? Yes No 5. List your references (letters should be included with this application): 1. Name, Title and Credentials

2 Employment 2. Name, Title and Credentials Employment

3 Okura Psych-Mental Health Fellow Application Mentor Form Name: Date: Address: Mailing address City State Zip code Phone: Degrees/Credentials: Employer: Organization/Agency Address City State Zip code 1. Membership in AAPINA from (date): 2. Number of years employed as a psych-mental health nurse: 3. Do you currently work with psych-mental health patients? Yes No a. If yes, how many hours per week do you work with patients? b. What percentage of your patient population are Asian Americans/Native Hawaiian or other Pacific Islanders? 4. If selected as a mentor will you be willing to attend and present at the annual AAPINA national conference? Yes No If selected as a mentor will you be willing to serve as a mentor for future fellows? Yes No 5. Do you have experience in mentoring? Yes No 5. Please describe your research and or scholarly activities:

4 6. Explain why you feel you would be a qualified mentor:

5 ATTENTION AAPINA MEMBERS AAPINA received the Okura Mental Health Leadership Foundation Scholarship Development grant for Asian/Pacific Islander nurses working in the area of mental health. This is a three year grant which begins in 2014 and we are looking for members (10 in this first year and 10 every year thereafter for three years) who are interested in applying to be a fellow in this leadership and scholarship development program. We are also looking for five senior members qualified to serve as mentors. If you are selected as a fellow you will be matched with a mentor based on similar areas of interest. This mentorship program will include coaching and instructional sessions on: navigating academia and clinical practice; dissemination of research results; networking skills; developing effective communication skills in leadership roles; reciprocity; art of negotiation; and conflict resolution. The aims of this proposed leadership and scholarship development program are: 1. Provide leadership and scholarship mentoring programs to promising API nurses interested in the mental health needs of Asian American (AA) and Native Hawaiian/other Pacific Islanders (NHOPI). Specifically, to develop leaders in the mental health field through research and clinical practice. 2. Develop professional and leadership skills of nurses at various levels in the field of mental health nursing. Applicants applying to be mentors must meet the following criteria: 1. Evidence of research and/or scholarly productivity in areas related to mental health of Asian American and Pacific Islanders. Evidence in this area includes: publications and presentations in conferences. 2. Evidence of advanced practice or leadership position in sites that provide mental health services to Asian Americans and Native Hawaiians/other Pacific Islanders. Evidence in this area includes advance certification in practice and/or administration, successful mentorship, publications and presentations. 3. Membership in AAPINA. Applicants applying to be a fellow must meet the following criteria: 1. Active membership in AAPINA for at least one year who is also a junior faculty or advance practice nurse 2. Must be willing to attend and contribute to the annual leadership seminar and mentorship program. Be willing to participate as alumni after fellowship period ends by assuming the role of mentor to new fellows in this program. 3. Demonstrates promising professional achievement in the mental health area Those interested in becoming a fellow please complete the following: 1. Complete the attached application form 2. In addition, submit a three page (single space) proposal addressing the following points: a. Reason for your interest in this program b. Description of your proposed project which should include: (i) goal(s), (ii) relevant background information; (iii) target population, (iv) methods/approach, and (v) expected outcome(s). Also include your task list and timeline. c. A current curriculum vitae d. Two letters of recommendation All of your documents should be incorporated into one file and sent to: Dr. Elizabeth Gonzalez at: ewg22@drexel.edu by February 15, 2014.